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NEEDS REQUEST

Before completing the request form below, please read the Liability Waiver. Thank you.

Clothing Item Request Form

* Required Field

Please complete this form so we can help fulfill your request.

First Name*:

Last Name*:

Foster Parent or Social Worker Name*:

Foster Care Agency*:

Email*:

Phone*:

Mobile:

Call or Text?

Call Text Either

Preferred Pickup Date/Time*:

Please complete the following information:

Childs Age:

Clothing Size:

Male or Female:

Baby Items Needed (please include what type of car seat, if any):

Other Requests:

I have read the Liability Waiver

			    	 
				
BUSINESS ADDRESS
Washington County Foster Closet
   3018 E Progress Dr.

                        Unit 1

						West Bend, WI 53095
CONTACT INFORMATION
 
						  
SOCIAL MEDIA
STORE HOURS
   By Appointment Only